Patient Portal Accessing of Sexually Transmitted Infection Test Results Among Adolescent and Young Adult Patients

Abstract

Background:

This study aimed to determine factors associated with the timely patient review of test results in the patient portal after receipt of sexually transmitted infection (STI) testing among adolescents and young adults (AYA) at a large urban hospital.

Methods:

We analyzed 12-month retrospective electronic health record (EHR) patient portal data among 19,193 patients aged 15 to 25 who received STI testing. Ordered logistic regression measured relationships of patient characteristics to review time, (defined as the time from when STI test results were released to the portal, to when AYA patients logged into their portal to view test results). Review time was categorized as, (a) no review, (b) review in >4 days, and (c) review in ≤4 days.

Results:

61.2% (11,759) of patients reviewed their STI test results in ≤4 days, while 28.2% (5,419) did not review results in the portal. Being <18 years old, male, Black or Hispanic/Latino, and living in a low socioeconomic status neighborhood were associated with a lower odds of review in ≤4 days.

Discussion:

Findings highlight AYA disparities in review time while suggesting a promising future for innovative STI interventions that leverage portals for engaging AYA in test result review.

Short Summary

Among patients aged 15–25-years-old tested for STIs in an urban hospital, female, older, and less socially disadvantaged patients were more likely to review patient portal test results in ≤4 days.

Introduction

Almost half (48.2%) of the 2.4 million reported sexually transmitted infections (STIs) in 2023 were concentrated among adolescents and young adults (AYA) aged 15 to 24 years old in the United States.¹ Social drivers of health (SDOH) influence the overrepresentation of STIs among AYA from socially disadvantaged communities and among Black and Hispanic/Latino populations.^1,2 AYA desire to use patient portals for prevention strategies that could mitigate the STI burden, such as, accessing and disclosing electronic STI test results to sex partners.^3–5

EHR patient portals are rapidly becoming vehicles for the delivery of patient-facing behavioral interventions.⁶ The 21^st Century Cures Act requires healthcare institutions to allow their patients to seamlessly access their medical records via smartphones and other digital media devices.⁷ Since smartphone ownership is nearly universal among teens across different genders, ages, races and ethnicities, and economic backgrounds – most young people are equipped with the devices needed to securely access their patient portal.⁸

Few studies have reported on AYA engagement with viewing electronic STI test results via a patient portal. Further, it is unclear how strategies intended to mitigate privacy concerns that render STI test results unavailable to adolescent minors (<18 years) may impact the reach of future prevention strategies leveraging the portal. We examined the use of a patient portal to view test results after STI testing among AYA at a large urban hospital.

Materials and Methods

Study Overview

In this human subjects-approved study, we analyzed electronic health record (EHR) patient portal data among patients aged 15 to 25 at an urban hospital receiving STI testing between March 2022 and April 2023. All patients were provided access to a portal account in English or Spanish; parents of adolescent minors had an option for a patient-proxy account. Counts of patients who received at least one specific STI test during the study period were assessed.

‘Review time’, was defined as the time from when STI test results were released to the portal, to when the AYA logged into their portal and selected either “Test Results List” or “Test Result Details.” Among patients that reviewed test results in the portal, the 85^th percentile of the ‘review time’ distribution (4 days) was used as a cutoff for variable categorization. ‘Review time’ was therefore categorized as: (a) no review, (b) review in > 4 days, and (c) review within 4 or fewer days. Details on specific STI tests viewed, and specified test results (e.g., positive/negative) were not available for analysis. The area of deprivation index (ADI) was used to identify AYA living in lower socioeconomic status neighborhoods (≥85^th-percentile).⁹ Patients’ total number of clinical encounters during the study period was also calculated for each patient.

Chi-square tests were used to evaluate differences in distributions of sample characteristics by review time. Multivariable ordered logistic regression was conducted to measure associations between patient characteristics and review time. Statistical significance was determined using a cutoff of P<.05. All calculations were conducted using Stata 18.0 (Stata Corp, College Station, TX).

Results

A total of 19,193 unique patients were included in the analysis (Table). Most patients received Chlamydia trachomatis (58.2%), Neisseria gonorrhoeae (55.6%), and Trichomonas vaginalis (54.8%) tests (Figure). Most patients reviewed their STI test results in ≤ 4 days of posting (61.2%; 11,759), while 28.2% (5,419) did not review results in the portal (Table). Almost half (47.9%) of adolescent minors reviewed test results in ≤ 4 days. Proxy account users performed no reviews. Patients aged 18–21 years-old and 22–25 years-old had, respectively, 2.26 (95%CI= 2.08, 2.45) and 2.53 (95%CI=2.32, 2.75) greater odds of review in ≤ 4 days compared to patients aged 15–17 years-old. Compared to females, AYA males had a 46% lower odds of review in ≤ 4 days (95%CI=0.51, 0.58). Patients identifying as, Black ([adjusted odds ratio [(aOR)=0.72; 95%CI=0.66, 0.78)] or Hispanic/Latino (aOR=0.39; 95%CI=0.35, 0.43), having fewer clinical encounters, and living in neighborhoods with an ADI ≥85^th-percentile had significantly lower odds of review in ≤ 4 days (Table).

Table:

Characteristics of 19,193 patients aged 15–25 years associated with the timely review of test results in the patient portal after receipt of STI testing in a large urban hospital, May 2022 - April 2023

	Total N=19,193		Review time						Odds of ‘Review in ≤ 4 days’ compared to ‘No review’ and ‘Review in > 4 days’
			No review; N=5,419		> 4 days; N=2,015		≤ 4 days; N=11,759
	N	column%	N	row%	N	row%	N	row%	Adjusted Odds Ratio	95% Confidence Interval
Age at the first STI test,
15–17 years	4,224	22.0	1,770	41.9	449	10.6	2,005	47.5	Reference
18–21 years	7,857	40.9	1,995	25.4	855	10.9	5,007	63.7	2.26	2.08, 2.45 c
22–25 years	7,112	37.1	1,654	23.3	711	10.0	4,747	66.7	2.53	2.32, 2.75 c
Sex
Female	13,919	72.5	3,390	24.4	1,389	10.0	9,140	65.7	Reference
Male	5,248	27.3	2,024	38.6	622	11.9	2,602	49.6	0.54	0.51, 0.58 c
Unknown/Missing	26	0.1	5	19.2	4	15.4	17	65.4	0.91	0.37, 2.27
Race/Ethnicity
Non-Hispanic White	5,781	30.1	1,178	20.4	638	11.0	3,965	68.6	Reference
Non-Hispanic Black	7,903	41.2	2,183	27.6	784	9.9	4,936	62.5	0.72	0.66, 0.78 c
Non-Hispanic Asian	1,126	5.9	188	16.7	132	11.7	806	71.6	1.13	0.96, 1.32
Hispanic/Latino	2,413	12.6	919	38.1	255	10.6	1,239	51.3	0.39	0.35, 0.43 c
Unknown/Missing	1,970	10.3	951	48.3	206	10.5	813	41.3	0.35	0.31, 0.40 c
National ADI percentile
<85	1,772	9.2	692	39.1	158	8.9	922	52.0	Reference
≥85	15,205	79.2	4,081	26.8	1,608	10.6	9,516	62.6	1.64	1.48, 1.82 c
Number of clinical encounter(s) in study period
1	7,802	40.7	3,327	42.6	857	11.0	3,618	46.4	Reference
2	4,259	22.2	1,120	26.3	514	12.1	2,625	61.6	1.84	1.70, 2.00 c
≥3	7,132	37.2	972	13.6	644	9.0	5,516	77.3	4.12	3.80, 4.45 c

^ap<.05;

^bp<.01;

^cp<.001.

Figure:

Percent of patients aged 15–25 years tested for specific sexually transmitted infections at a large urban hospital, N=19,193, May 2022 – April 2023

Discussion

This article underscores the importance of providing AYA access to their STI test results through patient portal platforms in line with the goals of the 21^st Century Cures Act. Most AYAs in our study used their patient portal to view results after STI testing. Findings suggest a promising future for addressing low AYA testing practices and the disclosure of STI testing histories with sexual partners through engagement with electronic STI test result review. Patients identified as more likely to not review test results in the portal aligns with U.S. data highlighting lower patient portal utilization among the individuals who are socioeconomically disadvantaged and/or Black or Hispanic/Latino; these groups additionally face significantly higher STI burdens.^10,11 However, disparities in review of results are not likely driven by access to digital devices. ⁷

AYA’s willingness to seek STI testing is critically impacted by whether sexual health services may be sought without parental/guardian knowledge.¹² This highlights the importance of strategies that prevent parents/guardians from accessing their child’s patient portal account.¹³ In some cases within our study sample, test results may have been accessed by individuals other than the patient, such as friends or family members, using the patient’s login credentials.^14,15 Blocking STI results from the portal and medical record requests may be another approach to improve privacy. Some patients in our sample may not have reviewed their results because the results were either unavailable or not released for review in their portal. However, not releasing results may inhibit the ability of sexually active adolescents to fully engage in their STI testing histories and potentially future innovations that leverage the portal. Pivotal opportunities remain for developers and health systems to prioritize designing and implementing evidence-based digital health tools that offer nuanced privacy protections for adolescent minors.

STI testing is also essential for disease prevention and control by identifying infectious individuals and promptly connecting them to curative treatment. However, testing rates remain low among AYA, especially males.^16,17 Studies consistently show significantly lower STI testing rates among AYA males compared to females, highlighting the need to increase male engagement in sexual healthcare services.¹⁸ Many AYA view patient portals as potentially effective tools for accessing STI testing services, including options for home-based testing.⁴ The electronic notification features in patient portals can also reduce the time to treatment for those who test positive for STIs.¹⁹

Future interventions could leverage patient portals and other digital tools to enhance AYA testing rates and reduce the period of infectivity by decreasing the time from diagnosis to treatment. However, it is crucial to develop effective strategies for engaging socially disadvantaged AYA with patient portals, ensuring they have access to innovative STI prevention interventions that could benefit them the most.